Impact of intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction on left ventricular perfusion and function: a 6-month follow-up gated 99mTc-MIBI single-photon emission computed tomography study.

PURPOSE: We investigated the impact of intracoronary injection of autologous mononuclear bone marrow cells (BMC) in patients with acute ST elevation myocardial infarction (STEMI) on left ventricular volumes, global and regional systolic function and myocardial perfusion. METHODS: The study included 39 patients with first anterior STEMI treated successfully with primary percutaneous coronary intervention. They were randomly assigned to the treatment group or the control group in a 2:1 ratio. The patients underwent baseline gated single-photon emission computed tomography (G-SPECT) 3-10 days after STEMI with quantitative and qualitative analysis of left ventricular perfusion and systolic function. On the following day, patients from the BMC treatment group were subjected to bone marrow aspiration, mononuclear BMC isolation and intracoronary injection. No placebo procedure was performed in the control group. G-SPECT was repeated 6 months after STEMI. RESULTS: Baseline and follow-up G-SPECT studies were available for 36 patients. At 6 months in the BMC group we observed a significantly enhanced improvement in the mean extent of the perfusion defect, the left ventricular perfusion score index, the infarct area perfusion score and the infarct area wall motion score index compared to the control group (p = 0.01-0.04). However, the changes in left ventricular volume, ejection fraction and the left ventricular wall motion score index as well as the relative changes in the infarct area wall motion score index did not differ significantly between the groups. CONCLUSION: Intracoronary injection of autologous mononuclear BMC in patients with STEMI improves myocardial perfusion at 6 months. The benefit in infarct area systolic function is less pronounced and there is no apparent improvement of global left ventricular systolic function.

Gated 99mTc-MIBI single-photon emission computed tomography for the evaluation of left ventricular ejection fraction: comparison with three-dimensional echocardiography.

OBJECTIVE: Parameters of left ventricular systolic function directly influence the management of patients with suspected coronary artery disease (CAD). Quantitative gated single-photon emission computed tomography (QGS; Cedars-Sinai Medical Center, Los Angeles, CA, USA) allows the computation of left ventricular ejection fraction (LVEF) from myocardial perfusion imaging studies which are frequently performed on patients with suspected CAD. Three-dimensional (3D) echocardiography is considered to be the echocardiographic "gold standard" for the quantification of LVEF. We sought to compare QGS with 3D echocardiography in the evaluation of EF in patients with suspected CAD. METHODS: Ninety-one consecutive patients with suspected CAD, scheduled for coronary angiography, underwent rest electrocardiographic-gated technetium-99m methoxyisobutylisonitrile SPECT (G-SPECT) with measurement of LVEF by QGS and transthoracic 3D echocardiography with off-line measurement of LVEF (Tomtec 4D LV Analysis 1.1). The diagnosis of CAD was based on coronary angiography, performed on every patient. RESULTS: Nine patients were excluded from the analysis owing to unsuitability for 3D echocardiography (8 patients) or G-SPECT (1 patient). In the remaining group of 82 patients, 71 (87%) had significant CAD, 34 (42%) had a history of myocardial infarction, and 50 (61%) had perfusion defects at rest G-SPECT images. The mean LVEF measured by QGS and 3D echocardiography was 53+/-13% and 53+/-10%, respectively. The mean difference in LVEF between 3D echocardiography and QGS was 0.1+/-6.0% (P=0.87), and the correlation between the values obtained by both methods was high (r=0.88, P<0.001). The largest discrepancies were observed in patients with small ventricular volumes. CONCLUSIONS: In patients undergoing diagnostic work-up for CAD, the measurement of LVEF by QGS algorithm provides high correlation and satisfactory agreement with the results of reference ultrasound method--3D echocardiography.

Radionuclide assessment of lower limb perfusion using 99mTc-MIBI in early stages of atherosclerosis.

BACKGROUND: The aim of the work was a scintigraphic evaluation of regional blood supply of thigh and calf muscles using 99mTc-MIBI as a radiopharmaceutical, in early stages of atherosclerosis revealed during ultrasonographic examination of lower limbs, in patients without typical clinical symptoms of chronic ischaemia of lower limbs and with preserved normal Doppler spectrum of blood flow. Moreover, basic relations between early signs of lower limb atherosclerosis and abnormal myocardial perfusion, as well as asymptomatic hypoperfusion of lower limbs, were analysed. MATERIAL AND METHODS: Stress and rest radionuclide study of lower limb muscles and myocardium using 99mTc-MIBI was performed in 47 men, who were divided into two groups based on ultrasonography results. The first group (group I) comprised 22 patients with early atherosclerotic changes in peripheral vessels and the second (group II) comprised 25 people with normal arteries. For the purposes of quantification of study results normal values of regional blood supply and indices of asymmetry at levels of thighs and calves, as proposed by Segall et al., were applied. Myocardial scintigrams were evaluated according to widely accepted rules (visual and semi quantitative--normative analysis). RESULTS: Mean values of stress and rest perfusion indices of thighs as well as calves in gr. I were statistically significantly lower (p < 0.001) than in gr. II. Incidence of asymmetry in the stress perfusion of calves and thighs was statistically significantly higher (p = 0.04) in patients with atherosclerotic changes as compared with the control group. Abnormal myocardial perfusion was found in 77% of patients from group I and in 28% from group II (p = 0.001). Reversible, stress induced ischaemia was found in 59% and 16%, resp. (p = 0.01). CONCLUSIONS: 1. Radionuclide study revealed a reduced stress as well as rest perfusion of lower limb muscles in clinically asymptomatic patients with atherosclerotic changes of lower limb vessels of low degree and a preserved normal Doppler blood flow spectrum. 2. Presence of early atherosclerotic changes in lower limb vessels implies a higher probability of asymptomatic hypoperfusion of lower limbs as well as coronary artery disease.

Detection of single-vessel coronary artery disease by dipyridamole stress echocardiography: no longer a problem?

UNLABELLED: We aimed to evaluate whether addition of myocardial contrast echocardiography (MCE) perfusion data improves the sensitivity of stress echocardiography for detection of single-vessel coronary artery disease (svCAD) and to compare the diagnostic value of MCE and single-photon emission computed tomography (SPECT) for detection of svCAD. METHODS: One hundred and three patients with suspected or known stable CAD underwent dipyridamole (0.84 mg kg(-1) intravenously over 4 min)-atropine (up to 1 mg intravenously) stress echocardiography combined with MCE. Wall motion abnormalities (WMA) and perfusion defects were assessed visually. Presence of CAD was detected by coronary angiography. RESULTS: Single-vessel coronary artery disease defined as >or=70% stenosis was detected in 30% of patients, whereas 26% of patients had svCAD defined as >or=50% stenosis. Presence of inducible WMA had 35% and 26% sensitivity for detection of svCAD defined as >or=70% and >or=50% stenosis, respectively. Concomitant evaluation of MCE increased the sensitivity to 74% (P = 0.005) and 56% (P = 0.053), respectively, using any inducible abnormality (WMA or perfusion defects) as a criterion. Presence of any (inducible or fixed) WMA had 77% and 59% sensitivity for detection of svCAD defined as >or=70% and >or=50% stenosis, respectively. In case of such criterion for stress test positivity, the improvement in sensitivity provided by addition of MCE (to 94% and 78%, respectively) did not reach statistical significance. CONCLUSIONS: Addition of MCE perfusion analysis during stress echocardiographical examination based on evaluation of inducible abnormalities improves the test sensitivity for detection of svCAD. This benefit is less apparent when fixed WMA and perfusion defects are incorporated into the stress test positivity criterion.

Accelerated stress real-time myocardial contrast echocardiography for the detection of coronary artery disease: comparison with 99mTc single photon emission computed tomography.

OBJECTIVE: The aims of this prospective study were to compare the diagnostic value of accelerated vasodilator stress real-time myocardial contrast echocardiography (MCE) and single photon emission computed tomography (SPECT) against coronary angiography and to evaluate whether the addition of MCE perfusion data improves the diagnostic accuracy of stress echocardiography. METHODS: A total of 103 patients with suspected or known stable coronary artery disease (CAD) underwent SPECT and accelerated high-dose dipyridamole (0.84 mg/kg intravenously for 4 minutes) atropine (up to 1 mg intravenously) stress real-time qualitative MCE. The presence of CAD was detected by coronary angiography. RESULTS: CAD defined as >or= 70% stenosis was detected in 77% of patients, whereas 86% of patients had CAD defined as >or= 50% stenosis. In a territory-by-territory analysis, the concordance between MCE and SPECT in detecting perfusion defects varied from 72.8% (kappa = 0.386) to 89.3% (kappa = 0.642). There were no significant differences between MCE and SPECT in sensitivity, specificity, and diagnostic accuracy for identifying patients with CAD. Combining MCE and wall motion abnormality analysis significantly improved the sensitivity of the test compared with wall motion abnormality analysis alone. CONCLUSIONS: Accelerated vasodilator stress real-time MCE yields a good concordance with SPECT in detection of perfusion defects and a similar diagnostic value for the detection of CAD. The addition of MCE perfusion data improves the diagnostic value of stress echocardiography.